Two years ago, 68-year-old Abbas Tyabali Suttarwala had four toes from his left foot amputated. Months after the surgery, his wounds refused to heal while the bleeding continued.
“By August 2011, my leg was the size of a football — I was told to go in for below-the-knee amputation. I was devastated. That’s when my family doctor suggested I try Dr Ramesh Juvekar’s Extracorporeal Shock Wave Therapy (ESWT) at Asha Parekh Hospital as a last resort,” says Suttarwala, who became Juvekar’s first patient.
For the last year and a half, Dr Juvekar has exposed Suttarwala’s wound to a series of low intensity sound waves, simulating the nerve cells and increasing the blood circulation in his leg. When we met Suttarwala at the hospital this week, he looked a happy man, and hailed Dr Juvekar as a “miracle worker”.
Shock wave therapy
Dr Juvekar, head of Non-Invasive Shockwave Therapy Department at the BCJ Hospital & Asha Parekh Research Centre and a practicing urologist, first found out about ESWT developed by scientists at Essen University in Germany, two years ago when he visited the country. The safety of the non-invasive technique in the fields of urology, cardiology and in curing small wounds such as ulcers has been proven following extensive clinical use throughout Europe.
On his return to Mumbai, Dr Juvekar decided to apply the technique on diabetic gangrenous wounds as well. “The past two years have been an uphill struggle. As a urologist, this wasn’t part of my specialisation. But I had no choice — no orthopaedic was willing to take up the challenge. Learning how to use the machine isn’t the problem, but understanding the mechanism and adapting it as per the patient’s problems is the challenge. It is not like a photocopy machine — we cannot apply the same procedure in each case,” states Dr Juvekar, who claims to be the only one in the country who practices the technique.
“Gangrene is a serious condition that occurs when tissues die or decay from a lack of blood supply. In this treatment, low energy shock waves are focused onto the affected area with the aid of ultrasound imaging and then these waves travel through tissues without damaging them. In short, due to shock wave therapy new blood vessels are formed as a network of capillary blood vessels, to heal the affected area and thus salvage the limb,” he explains.
The treatment differs from patient to patient. Three main factors determine the duration of recovery — age, infection and patient’s compliance. “It is also essential that the patient’s diabetes is kept under control,” Dr Juvekar adds.
Medical fraternity not convinced
Juvekar claims to have treated 25 patients successfully in the past two years, but he is aware that his application of ESWT to treat gangrenous wounds is controversial. Small wonder then that many of his colleagues have distanced themselves from endorsing his methods.
Surgeon Dr Prem Colaco, who has done a comparative study on diabetic foot, believes that conventional teaching rejects the idea of treating gangrene (or even impending gangrene). “When you talk of gangrene, you are referring to the necrosis of tissue (completely dead or decaying tissue). In such situations, most often there is no option but to amputate,” says Dr Colaco.
Unlike ulcers, gangrenous wounds are not superficial wounds, which make them impossible to treat. “Even if the infection subsides, the wound will never completely heal because it is impossible to bring the blood supply back,” he says. He argues that even if Juvekar’s claim of treating 25 gangrene patients successfully is true, it isn’t enough to prove that the technology works in general.
Orthopaedic surgeon Dr Parag Munshi joins Dr Colaco in his cynicism of the treatment. “In my opinion, I don’t think this treatment works,” he says. So while Juvekar continues the method he learnt from Germany, scepticism abounds among colleagues. Whether this scepticism is justified or a mere resistance to a revolutionary technique, only time and a lot more case studies can tell.
Jayantibhai Soni, Borivli, 68
Thanks to his diabetes, Soni had no sensation in both his feet and didn’t realise when he was wounded. Last year in July, he had to undergo an amputation on one toe on his right foot after the infection spread. When the wound didn’t heal, a friend suggested he visit Asha Parekh Hospital. So he made his first trip on December 11, 2012. Soni was admitted to the hospital for 12 days, which is when he began his ESWT and magnetic healing at the StossWelle Centre. Now, he continues his treatment every alternate day. “The pus has stopped and the blood supply is slowly improving, but I’m still not supposed to walk too much. I’ve been told that my right foot will be fine within 15 days to a month,” says Soni.
What is ESWT?
Extracorporeal Shock wave therapy or ESWT is a method of treatment for multiple tendon pain. Research indicates that there is significant reduction in intensity of pain with this treatment. However, the medical value of ESWT is disputed even as the use of ESWT continues to expand across medical disciplines, such as cardiology, urology and wound applications. Presently this technology is only approved in the US by the Food and Drug Administration (FDA) for treatment of tennis elbow. Approvals are pending for the treatments of shoulder tendinitis, achilles tendonitis, stress fractures and diabetic wounds. There are several theories as to how ESWT may or may not help promote better healing. The most accepted one is that the microtrauma of the repeated shock wave to the affected area creates new blood flow into the area. It is this new blood flow that promotes tissue healing.